How Are Payer Strategies and Prescriber Preferences Shaping the Non-Insulin Treatment Algorithm?

Although a high opportunity market, the therapeutic space for type 2 diabetes (T2D) is set to become even more competitive with forthcoming entrants in Brazil, Mexico, and Argentina, such as long-acting GLP-1 receptor agonists and DPP-IV inhibitors, and the novel fixed-dose combinations of SGLT-2 inhibitors/metformin and of DPP-IV inhibitors/SGLT-2 inhibitors. Emerging therapies will likely be met with increased formulary and budgetary restrictions in these markets. As local and national governments have to bear the burden of treating a growing population with the disease, it is left to know if the treatment algorithm for T2D will advance as the treatment armamentarium evolves, or if it will stagnate even though more effective, yet more expensive therapies become available in these markets.

Questions Answered in This Report:

  • Explore current and evolving drug coverage and prescribing trends. How does coverage of current non-insulin antidiabetic agents vary between Brazil, Mexico, and Argentina? Which of these agents are included in drug formularies of government-sponsored and/or social security programs? How do prescribing habits vary between countries, practice settings (public versus private), and drug classes? What are payers’ attitudes toward current GLP-1 receptor agonists, DPP-IV inhibitors, and SGLT-2 inhibitors? Which access/reimbursement constraints are faced by GLP-1 receptor agonists, DPP-IV inhibitors, and SGLT-2 inhibitors, and how do these constraints outline prescribing patterns? What are the key drivers in the prescribing of these drug classes and within each class?

  • Explore the outlook for emerging non-insulin antidiabetics. How are payers’ attitudes toward emerging therapies? To what extent do payers perceive the long-acting GLP-1 receptor agonists and DPP-IV inhibitors, and the novel fixed-dose combinations of SGLT-2 inhibitors/metformin and of DPP-IV inhibitors/SGLT-2 inhibitors as real clinical improvements? How do clinicians expect to prescribe them? How do payers expect access to T2D treatments to evolve in the next 2-3 years? What clinical and economic features of emerging non-insulin antidiabetic agents would allow for faster formulary inclusion? What market access obstacles will these novel therapies face? Which clinical and reimbursement/coverage opportunities can drug developers benefit from to better position their products in these markets? What role will head-to-head and pharmacoeconomic outcomes play in the coverage of novel non-insulin antidiabetic treatments versus current standards of care?


This Emerging Physician & Payer Forum surveys 152 endocrinologists and primary care physicians to explore the prescribing and access environment for key non-insulin treatments for T2D, with a focus on current and emerging DPP-IV inhibitors, GLP-1 receptor agonists, and SGLT-2 inhibitors, and how it will evolve in these countries in the next 2-3 years. Interviewees were required to be influential in determining patient access to therapies for T2D at the institutional or regional/national level, and came from the following backgrounds:

- Brazil: Head of pharmaceutical assistance programs at São Paulo State; head of the pharmaceutical division of a major public hospital in São Paulo, consultant for the São Paulo State Department of Health and the Ministry of Health, specialist in pharmacoeconomics; director of the drug standardization committee and audit department at a major HMO; medical auditor responsible for the disease and portfolio management at a major insurance company, member of the drug standardization committee of the institution.

- Mexico: Coordinator of the National Staged Diabetes Medical Management Program at ISSSTE; endocrinologist responsible for the diabetes and obesity program at a family medicine unit from IMSS; endocrinologist KOL, director of the endocrinology department at a major private hospital in Mexico, member of the Board of Governors of Mexico State at the Mexico chapter of the American College of Physicians.

- Argentina: Medical director of management, prevention, and treatment programs from a major national obra social; chief of the endocrinology department at major hospital in Buenos Aires; member of the SADE and the ALAD; chief of the audit department at a major private hospital.

Author(s): Susana Silva, B.S./M.S.
Andreia Ribeiro, Ph.D.

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